JP2016511013A - Treatment instrument holding device, endoscope, and medical system - Google Patents

Abstract

The treatment instrument holding apparatus includes a flexible insertion portion having a distal end and a base end, in which a treatment instrument channel into which the plurality of treatment instruments are inserted is formed, and each of the plurality of treatment instruments in the treatment instrument channel. The drive unit for advancing and retracting in the treatment instrument channel, the operation unit for operating the plurality of treatment instruments, and the treatment instrument channel of the treatment instrument in a state of protruding from the distal end of the treatment instrument channel among the plurality of treatment instruments And a control unit for controlling the amount of protrusion from the projector.

Description

The present invention relates to a treatment instrument holding device, an endoscope, and a medical system.
This application claims priority based on provisional application 61/768873 filed in the United States on February 25, 2013, the contents of which are incorporated herein by reference.

  Conventionally, in medical treatment using an endoscope, it is known to perform medical treatment while replacing a plurality of treatment tools with respect to the endoscope. For example, Patent Document 1 discloses an endoscope treatment system to which a plurality of treatment tools are attached.

  When replacing a treatment instrument inserted through the treatment instrument channel of an endoscope with another treatment instrument, it is necessary to completely remove the treatment instrument from the treatment instrument channel and insert another treatment instrument into the treatment instrument channel. is there.

JP-A-2005-080983 JP 2006-087474 A JP 2005-204995 A

  The endoscope described in Patent Document 1 includes a thick treatment instrument channel into which a plurality of treatment instruments can be inserted together. However, when each treatment tool is switched, the treatment tools interfere in the thick treatment tool channel, and the operator may not be able to operate the treatment tool as intended.

  The endoscope described in Patent Document 2 includes an electric mechanism that removes a treatment tool from a treatment tool channel and inserts another treatment tool into the treatment tool channel when the treatment tool is replaced. In this endoscope, there is a space for winding the treatment tool in the operation portion of the endoscope, so the endoscope is large and heavy.

  The endoscope described in Patent Document 3 has a plurality of treatment instrument insertion channels. Since the distal end side is integrated into one from the middle of the treatment instrument insertion channel, a rigid linear portion is required at the proximal end portion of the insertion portion of the endoscope. In this endoscope, since the insertion of the treatment tool is manually controlled, the treatment tool protrusion amount from the distal end opening is controlled during the treatment (during operation), so that the treatment tools at the time of electric insertion are not intended. Preventing interference is not considered.

In a treatment instrument having a plurality of joints at the tip, the distance between the bending centers of each joint is a substantial rigid length. When a plurality of joints are held in a straight line state, the straight part formed by each joint has a substantially hard length. The endoscope disclosed in Patent Document 3 does not consider treatment tool replacement when such a substantial rigid length exists.
Further, in the endoscope disclosed in Patent Document 3, the amount of protrusion of the treatment portion from the distal end of the endoscope insertion portion is not considered when the treatment tool is replaced.

  The present invention has been made in view of such circumstances, and provides a treatment instrument holding device, an endoscope, and a medical system that can easily switch a plurality of treatment instruments without interfering with each other. With the goal.

  According to the first aspect of the present invention, the treatment instrument holding device that holds a plurality of treatment instruments has a distal end and a base end, and is a flexible insertion having a treatment instrument channel through which the plurality of treatment instruments are inserted. A drive unit that causes the treatment tool channel to advance and retract each of the plurality of treatment tools within the treatment tool channel, an operation unit that operates the plurality of treatment tools, and the protrusion protruding from the distal end of the treatment tool channel And a control unit for controlling a protruding amount of the treatment tool from the treatment tool channel. The insertion portion includes a distal end tube portion that is one conduit having an opening on the distal end side of the insertion portion, and a first proximal end tube portion that is one conduit having an opening on the proximal end side of the insertion portion. The second base end pipe part which is one duct having an opening on the base end side of the insertion part, the front end pipe part, the first base end pipe part and the second base end pipe part communicate with each other. In this state, the distal end tube portion, the first proximal end tube portion, and the second proximal end tube portion are connected to each other, and a connecting portion disposed in the insertion portion.

  According to the second aspect of the present invention, in the treatment instrument holding apparatus according to the first aspect, the insertion portion is disposed on a flexible flexible tube portion and a distal end side of the insertion portion, and the flexible tube portion And a bending portion that is connected to and bent. The connecting portion may be disposed in the flexible tube portion and in the vicinity of a boundary between the flexible tube portion and the bending portion.

  According to the third aspect of the present invention, in the treatment instrument holding device according to the first aspect or the second aspect, the drive unit is configured to be connected to the outside of the insertion part from the proximal end side of the treatment instrument channel in the treatment instrument. The part inserted into the treatment instrument channel in the treatment instrument is moved forward and backward in the direction of the central axis of the treatment instrument channel by holding a part of the part that has been fed out and moving the retained part forward and backward. It may be allowed.

  According to a fourth aspect of the present invention, in the treatment instrument holding device according to the first aspect or the second aspect, the drive unit includes a treatment instrument inserted into the first proximal end tube part, and the distal end tube part. A first drive part that moves forward and backward by a length between the distal end of the distal end and the connection part, and a treatment instrument that is inserted into the second proximal end pipe part, the distal end of the distal end pipe part and the connection part A second drive unit that moves forward and backward by a length between the first drive tube and a treatment device that is inserted into the second proximal tube when the treatment device inserted into the first proximal tube is in the distal tube. When the treatment instrument that is drawn into and held in the second proximal end tube portion immediately before the connecting portion and is inserted into the second proximal end tube portion is in the distal end tube portion, it is inserted into the first proximal end tube portion. So that the treatment tool is pulled into the first proximal end tube portion immediately before the connection portion, and held. Serial and first driving unit and the second driving unit and the linkage unit operated cooperatively, may have.

  According to a fifth aspect of the present invention, in the treatment instrument holding device according to any one of the first aspect to the fourth aspect, the shape of a cross section perpendicular to the central axis of the distal end tube portion, and the first base The shape of the cross section orthogonal to the central axis of the end tube portion may be substantially the same as the shape of the cross section orthogonal to the central axis of the second proximal tube portion. An area of a cross section perpendicular to the central axis of the distal end pipe part, an area of a cross section perpendicular to the central axis of the first proximal pipe part, and an area of a cross section perpendicular to the central axis of the second proximal pipe part May be substantially the same.

  According to a sixth aspect of the present invention, in the treatment instrument holding apparatus according to the fifth aspect, the treatment instrument is configured to treat a subject to be treated, and the treatment instrument connected to the treatment section. You may provide the elongate part inserted in a channel. When the distal end tube part is capable of inserting the treatment part and the long part in only one treatment instrument and simultaneously inserting the treatment part and the long part in two or more treatment instruments The treatment part and the long part may be a tube having a size that interferes with each other.

According to a seventh aspect of the present invention, in the treatment instrument holding device according to any one of the first to sixth aspects, the treatment instrument may include a first treatment instrument and a second treatment instrument. Good. The control unit records the protrusion amount of the first treatment tool protruding from the distal end of the treatment instrument channel, and pulls in the first treatment instrument protruding from the distal end to place the second treatment instrument in the treatment instrument channel. When projecting from the distal end, the projecting amount of the second treatment instrument from the treatment instrument channel may be limited so that the second treatment instrument is projected only to the recorded projection amount.

  According to an eighth aspect of the present invention, an internal vision comprising: the treatment instrument holding device according to any one of the first aspect to the seventh aspect; and an imaging unit that is provided in the insertion unit and images the treatment target. It may be a mirror.

  A medical system according to a ninth aspect of the present invention includes a treatment instrument holding device according to any one of the first aspect to the seventh aspect, a plurality of treatment instruments for treating a treatment target, and the treatment instrument holding And a manipulator for operating the plurality of treatment instruments. The plurality of treatment tools include: a treatment part that performs treatment on the treatment target; a long part that is connected to the treatment part and is inserted into the treatment tool channel; and the treatment part and the long part. A joint part that is connected to change a posture of the treatment part with respect to the long part; and a wire that is arranged in the long part and transmits a force for operating the joint part. The manipulator includes a master manipulator that receives an operation input from an operator, a slave manipulator that is electrically connected to the master manipulator and operates the wire in accordance with the operation input to the master manipulator, and the master manipulator, A control unit that is electrically connected to the slave manipulator and controls the posture of the joint unit. The control portion relaxes the joint portion when a stop command for the treatment instrument having the joint portion is issued to the manipulator in a state where the joint portion is extended from the distal end tube portion. In this way, a signal for operating the wire is generated and output to the slave manipulator. When the joint portion is in a relaxed state by the signal, the control portion positions the treatment portion and the elongated portion in the first proximal end tube portion or the second proximal end tube portion. Until then, a signal to be pulled in is output to the slave manipulator.

  According to the treatment instrument holding device of each aspect described above, a plurality of treatment instruments can be easily switched in a short time without interfering with each other.

1 is an overall view of a treatment instrument holding device and a medical system according to a first embodiment of the present invention. It is a mimetic diagram showing the treatment implement holding device concerning a 1st embodiment of the present invention. It is a schematic diagram which shows an example of the treatment tool attached to the treatment tool holding | maintenance apparatus which concerns on 1st Embodiment of this invention. It is a schematic diagram which shows the state at the time of use of the treatment tool holding | maintenance apparatus which concerns on 1st Embodiment of this invention. It is a schematic diagram which shows one process at the time of use of the treatment tool holding | maintenance apparatus which concerns on 1st Embodiment of this invention. It is a schematic diagram which shows one process at the time of use of the treatment tool holding | maintenance apparatus which concerns on 1st Embodiment of this invention. It is a schematic diagram which shows one process at the time of use of the treatment tool holding | maintenance apparatus which concerns on 1st Embodiment of this invention. It is a schematic diagram which shows a part of treatment tool holding | maintenance apparatus which concerns on 2nd Embodiment of this invention. It is a schematic diagram which shows a part of treatment tool holding | maintenance apparatus which concerns on 3rd Embodiment of this invention. It is a schematic diagram which shows a part of treatment tool holding | maintenance apparatus which concerns on 4th Embodiment of this invention. It is a schematic diagram which shows a part of treatment tool holding | maintenance apparatus which concerns on 5th Embodiment of this invention. It is a schematic diagram which shows a part of treatment tool holding | maintenance apparatus which concerns on 6th Embodiment of this invention. It is a typical enlarged view which shows a part of treatment tool holding | maintenance apparatus which concerns on 6th Embodiment of this invention. It is a schematic diagram which shows a part of treatment tool holding | maintenance apparatus which concerns on 7th Embodiment of this invention. It is a flowchart for demonstrating the process of the treatment tool replacement | exchange in the treatment tool holding | maintenance apparatus which concerns on 1st Embodiment of this invention.

(First embodiment)
1st Embodiment of the treatment tool holding | maintenance apparatus of this invention, an endoscope, and a medical system is described. FIG. 1 is an overall view of the treatment instrument holding device 1 and the medical system 150 according to the first embodiment of the present invention. FIG. 2 is a schematic diagram showing the treatment instrument holding device 1 according to the first embodiment of the present invention. FIG. 3 is a schematic diagram showing an example of the treatment instrument 120 attached to the treatment instrument holding apparatus 1 according to the first embodiment of the present invention. FIG. 2 is a diagram schematically illustrating the treatment instrument holding device 1 shown in FIG.
A medical system 150 (see FIG. 1) according to the present embodiment includes a treatment instrument 120 (see FIG. 3), a treatment instrument holding apparatus 1 (see FIG. 2), and a manipulator 151. The treatment tool 120 treats a living tissue. The treatment tool holding device 1 holds the treatment tool 120. The manipulator 151 operates the treatment tool 120 and the treatment tool holding device 1.

  First, the configuration of the treatment tool 120 will be described. As shown in FIG. 3, the treatment tool 120 attached to the treatment tool holding apparatus 1 may be a known endoscope treatment tool (forceps, knife, brush, etc.) used together with a flexible endoscope, for example. .

  The treatment instrument 120 according to the present embodiment includes a treatment part 121, a joint part 124, a long part 122, an attachment part 123, and an adapter part 125. The treatment unit 121 performs a treatment on a tissue that is a treatment target. The long portion 122 is connected to the joint portion 124. The joint part 124 is connected to the treatment part 121. The attachment portion 123 is connected to the long portion 122 and can be attached to the moving portion 27 or the moving portion 47 described later. The adapter unit 125 includes an actuator that operates the treatment unit 121 and the joint unit 124.

  The adapter part 125 is disposed so as to bend the joint part 124 via a bending wire (not shown) disposed in the long part 122. The adapter unit 125 according to the present embodiment is electrically connected to a slave manipulator 152 described later. In addition, the adapter unit 125 operates the treatment unit 121 and the joint unit 124 in accordance with a signal generated from the slave manipulator 152.

Next, the configuration of the treatment instrument holding apparatus 1 will be described.
As shown in FIG. 2, the treatment instrument holding apparatus 1 according to this embodiment includes a long insertion portion 2, an operation portion 12, and a drive portion 20. The insertion portion 2 has a distal end 2a and a proximal end 2b. The operation unit 12 is provided at the proximal end of the insertion unit 2. The drive unit 20 operates the treatment instrument 120. The treatment instrument holding apparatus 1 according to the present embodiment includes a base 18 to which the operation unit 12 and the drive unit 20 are attached.

  As shown in FIG. 1, the insertion portion 2 of the treatment instrument holding apparatus 1 includes a flexible tube portion 3, a bending portion 4, a channel tube 5, and an imaging unit 11. The flexible tube portion 3 is inserted into the body. The bending portion 4 is disposed on the distal end side of the flexible tube portion 3 and connected to the flexible tube portion 3. The channel tube 5 is disposed inside the flexible tube portion 3 and the bending portion 4. The imaging means 11 is disposed on the distal end side of the bending portion 4.

  The flexible tube portion 3 is a flexible tubular long member formed of a resin tube, a tube formed by knitting a metal wire, or the like.

The bending portion 4 is a flexible cylinder that performs a bending operation by driving an electric pulling means 14 for bending operation, which will be described later, provided in the operation unit 12. The configuration of the bending portion 4 may be a known configuration applicable to a flexible endoscope apparatus. For example, by pulling the bending operation wire 14a according to the operation of the electric pulling means 14, the bending portion 4 is bent in two directions or four directions. The bending operation wire 14 a is connected to the electric traction means 14 of the operation unit 12 through the inside of the bending portion 4 and the flexible tube portion 3. Instead of the electric traction means 14, the bending portion 4 may be operated by an angle knob for manual operation.
The channel tube 5 is a flexible tubular member branched into two at a part of the insertion portion 2. The channel tube 5 has a distal end tube portion 6 and a proximal end tube portion 7 (a first proximal end tube portion 8 and a second proximal end tube portion 9). The distal end pipe part 6 is one pipe line arranged on the distal end 2 a side of the insertion part 2. The first base end pipe part 8 and the second base end pipe part 9 are two pipe lines arranged on the base end 2 b side of the insertion part 2. The portion where the channel tube 5 is branched into two is connected in a state where the distal end tube portion 6 and the proximal end tube portion 7 are in communication with each other, and the connection portion 10 between the distal end tube portion 6 and the proximal end tube portion 7 is connected. is there.

  The first base end tube portion 8 and the second base end tube portion 9 each have an opening at the base end 5 b of the channel tube 5. An opening on the base end 5 b side of the channel tube 5 is arranged in the operation unit 12 and connected to a treatment instrument insertion port 15 described later provided in the operation unit 12.

  The channel tube 5 has a distal end 5 a fixed to the distal end 2 a of the insertion portion 2 and a proximal end 5 b provided on the operation portion 12. The connection portion 10 in the channel tube 5 is arranged in the vicinity of the boundary between the flexible tube portion 3 and the bending portion 4 inside the flexible tube portion 3. Since the channel tube 5 is one conduit in the bending portion 4, the bending portion 4 is flexible and easy to bend as compared with the case where two conduits are arranged in the bending portion 4.

  The intermediate portion of the channel tube 5 may be connected to the inner surface of the insertion portion 2 at several places, or may not be connected to the insertion portion 2. Since the channel tube 5 is arranged so as to be slack enough to move within the insertion portion 2, the flexibility of the flexible tube portion 3 and the bending portion 4 can be maintained high.

  The tip tube portion 6 of the channel tube 5 has a circular cross section perpendicular to the central axis of the tip tube portion 6 and has a cavity. The inner diameter dimension of the distal end tube portion 6 is such that the treatment portion 121 and the elongated portion 122 in the treatment instrument 120 shown in FIG. 3 can be freely advanced and retracted along the central axis of the distal end tube portion 6, and the treatment portion 121 and This is a size that allows the long portion 122 to be rotated about the central axis of the distal end tube portion 6 as a rotation center. The shape and area of the cross section perpendicular to the central axis of each of the first proximal pipe portion 8 and the second proximal pipe portion 9 are substantially equal to the shape and area of the cross section perpendicular to the central axis of the distal tube portion 6. That is, the shape of the cross section orthogonal to the central axis of the distal end tube portion 6, the shape of the cross section orthogonal to the central axis of the first proximal tube portion 8, and the central axis of the second proximal tube portion 9. The cross-sectional shape is substantially the same. The area of the cross section orthogonal to the central axis of the distal end tube portion 6, the area of the cross section orthogonal to the central axis of the first proximal end tube portion 8, and the cross section orthogonal to the central axis of the second proximal end tube portion 9 Is substantially equal to the area.

  In the connecting portion 10, the distal end tube portion 6, the first proximal end tube portion 8, and the second proximal end tube portion 9 are connected to each other and arranged in a Y shape. For example, the angle formed by the central axis of the first proximal tube portion 8 and the central axis of the second proximal tube portion 9 is less than 90 °, and the central axis of the first proximal tube portion 8 and the distal tube portion 6 The angle formed by the central axis may be 90 ° or more, and the angle formed by the central axis of the second proximal tube portion 9 and the central axis of the distal tube portion 6 may be 90 ° or more. In this case, the treatment instrument 120 can be smoothly pushed from the proximal tube portion 7 to the distal tube portion 6 via the connection portion 10. The connection state of the distal end tube portion 6, the first proximal end tube portion 8, and the second proximal end tube portion 9 is not limited to the Y shape.

  The lumen of the channel tube 5 is a treatment instrument channel through which the treatment instrument 120 can pass. The inner diameter of the distal end tube portion 6 need not be large enough to allow the treatment portion 121 and the long portion 122 of the two treatment tools 120 to be inserted simultaneously. The inner diameter of the distal tube portion 6 is large enough to allow the treatment portion 121 and the long portion 122 of one treatment tool 120 to be inserted, and the treatment portion 121 and the long portion 122 of the two treatment tools 120 are simultaneously inserted. Is a size that does not fit. That is, the inner diameter dimension of the distal end pipe part 6 is a dimension that interferes with each other when the treatment part 121 and the long part 122 in the two treatment instruments are simultaneously inserted. For this reason, the extent to which the elongate part 122 meanders in the front-end | tip pipe part 6 can be restrained low. Since the size of the inner diameter of the distal end tube portion 6 is such that the treatment portion 121 and the long portion 122 of only one treatment instrument 120 can be passed through, the long portion 122 along the central axis of the channel tube 5. The amount of force applied by the operator from the operation unit 12 side when advancing and retreating can be efficiently transmitted to the treatment unit 121.

  The material of the channel tube 5 is preferably a material having a small frictional resistance against the treatment part 121 and the long part 122 of the treatment instrument 120. The inner surface of the channel tube 5 may be a surface that has been subjected to a surface treatment that reduces frictional resistance against the treatment portion 121 and the long portion 122.

The imaging means 11 is provided in the insertion portion 2 for the purpose of imaging the tissue to be treated in the body and the treatment tool 120 attached to the treatment tool holding device 1. In the present embodiment, the treatment instrument holding apparatus 1 has a function as an endoscope in that visual observation can be performed. The configuration of the imaging unit 11 is not particularly limited.
The operation unit 12 includes a main body 13, electric traction means 14, and a drive unit 20. The main body 13 is fixed to the proximal end of the flexible tube portion 3. The electric traction means 14 is provided in the main body 13 and pulls the bending operation wire 14a. The drive unit 20 is provided to move the treatment tool 120 attached to the treatment tool holding apparatus 1 and hold the treatment tool 120. A bending operation wire 14a connected to the bending portion 4 described above is wound around the pulley or sprocket 14b. The electric traction means 14 is provided to rotate the pulley or sprocket 14b around the rotation axis of the pulley or sprocket 14b. Instead of the electric traction means 14 of the operation unit 12, a knob for manually pulling the bending operation wire 14 a may be provided. A known mechanism for pulling the bending operation wire 14a, such as a rack and pinion mechanism, may be provided.

  A channel tube 5 extends from the flexible tube 3 inside the main body 13. The main body 13 is provided with a treatment instrument insertion port 15 communicating with the opening on the proximal end side of each channel tube 5. One treatment instrument insertion port 15 is provided for each of the proximal-side channel tubes 5 (the first proximal tube portion 8 and the second proximal tube portion 9) branched into a plurality of branches. In the present embodiment, two treatment instrument insertion ports 15 (a first treatment instrument insertion port 16 and a second treatment instrument insertion port 17) are provided in the operation unit 12. The treatment instrument insertion port 15 has an inner diameter such that a treatment section 121 and a long section 122 in a treatment instrument 120 described later can be inserted. The treatment instrument insertion port 15 may be arranged not in the operation unit 12 but in the flexible tube unit 3.

The drive unit 20 includes a first drive unit 21, a second drive unit 41, and a cooperation unit 55. The first drive unit 21 moves the treatment instrument 120 inserted into the first one of the two treatment instrument insertion ports 15 (the first treatment instrument insertion port 16 in the present embodiment). The second drive unit 41 moves the treatment instrument 120 inserted into the second of the two treatment instrument insertion ports 15 (second treatment instrument insertion port 17 in the present embodiment). The cooperation unit 55 causes the first drive unit 21 and the second drive unit 41 to perform a cooperative operation.
The first drive unit 21 has a base 22 and a moving unit 27. The base 22 is detachably attached to the base 18. The moving unit 27 moves back and forth with respect to the base unit 22. The first drive unit 21 moves the treatment tool 120 inserted through the first proximal end tube unit 8 forward and backward by the length between the distal end of the distal end tube unit 6 and the connection unit 10.

  The base portion 22 includes a linear rack 23 and a connecting conduit 24 that communicates with the treatment instrument insertion port 15.

  The connection pipe line 24 includes a tube 25 and a tube 26. The tube 25 is a soft tube communicated with the treatment instrument insertion port 15. The tube 26 is a hard tube having one end connected to the flexible tube 25 and fixed to the base 22. The elongated portion 122 of the treatment instrument 120 shown in FIG. 3 is inserted into the flexible tube 25 and the rigid tube 26 in the connection conduit 24. The long tube 122 of the treatment instrument 120 is held in a straight state in the rigid tube 26 in the connection pipe line 24.

  The moving unit 27 includes a main body 30 and a holding unit 31. The main body 30 is provided with a pinion 28 that meshes with the rack 23 and a motor 29 that operates the pinion 28. The holding unit 31 holds the treatment instrument 120.

The holding portion 31 is detachably connected to the moving portion 27 and holds the proximal end portion of the long portion 122 in the treatment instrument 120. The holding part 31 has a tube 32 and a connecting part 33. The tube 32 is a rigid tube that can be inserted into the tube 26 in the connection conduit 24 and into which the long portion 122 of the treatment instrument 120 can be inserted. The connecting portion 33 can attach the tube 32.
The tube 32 holds the long portion 122 so that the long portion 122 of the treatment instrument 120 is in a straight line state.

  The connecting portion 33 has a through hole through which the tube 32 is inserted, and is configured so that the tube 32 can be fixed in the through hole.

  In the present embodiment, the moving portion 27 moves forward and backward with respect to the base portion 22 by the driving force of the motor 29 along the linear direction in which the rack 23 extends. Therefore, the moving unit 27 moves so as to approach or separate from the opening 24b on the proximal end side in the connection pipe line 24.

  The second drive unit 41 has the same configuration as the first drive unit 21. The second drive unit 41 has a base 42 and a moving unit 47. The base portion 42 has a rack 43 and a connecting pipe 44. The moving unit 47 includes a main body 50 and a holding unit 51. The main body 50 includes a pinion 48 and a motor 49. The second drive unit 41 moves the treatment tool 120 inserted through the second proximal end tube unit 9 forward and backward by the length between the distal end of the distal end tube unit 6 and the connection unit 10.

  The connection conduit 44 has a tube 45 and a tube 46. The tube 45 is a soft tube communicated with the treatment instrument insertion port 15. The tube 46 is a hard tube having one end connected to the soft tube 45 and fixed to the base 42. The elongated portion 122 of the treatment instrument 120 shown in FIG. 3 is inserted through the soft tube 45 and the hard tube 46 in the connection conduit 44. The rigid tube 46 in the connection conduit 44 is configured to hold the long portion 122 of the treatment instrument 120 in a straight state.

  The holding part 51 includes a tube 52 through which the treatment instrument 120 is inserted and a connecting part 53. The connecting portion 53 connects the tube 52 and the base portion 42.

  The positional relationship between the rack and the pinion in the rack and pinion may be opposite to the above-described positional relationship. The bases 22 and 42 may be provided with the pinions 28 and 48 and the motors 29 and 49, and the moving parts 27 and 47 may be provided with the racks 23 and 43.

  The cooperation unit 55 includes an input unit 56, a detection unit 57, and an output unit 58. The input unit 56 receives an input from the operator through the master manipulator 154. Input from the operator through the master manipulator 154 is performed to operate the treatment instrument 120. The detection unit 57 detects the positions of the first drive unit 21 and the second drive unit 41. The output unit 58 supplies electric power for driving the motor 29 in the first drive unit 21 and the motor 49 in the second drive unit 41 connected to the input unit 56 and the detection unit 57.

  The detection unit 57 may include means for measuring the movement amount of the first drive unit 21 and the second drive unit 41 such as an encoder. The detection unit 57 may include a switch 65 described later that determines that the moving units 27 and 47 have reached predetermined positions with respect to the base units 22 and 42.

  The input unit 56 selects one of the treatment instrument 120 attached to the first drive unit 21 and the treatment instrument 120 attached to the second drive unit 41 from the operator through the master manipulator 154. An operation input is input. When an operation input from the operator is input to the input unit 56, the input unit 56 refers to the positions of the first drive unit 21 and the second drive unit 41 detected by the detection unit 57 and refers to the first drive unit 21. And the positional relationship between the second drive unit 41 and the second drive unit 41. The input unit 56 controls the output unit 58 so that the moving unit 47 provided in the driving unit 20 on the side opposite to the side selected in the operation input is separated from the opening on the proximal end side in the connection pipeline 44. . The output unit 58 drives the motor 49 according to control from the input unit 56. Furthermore, the input unit 56 controls the output unit 58 so that the moving unit 27 provided in the drive unit 20 on the side selected in the operation input is brought close to the opening 24b on the proximal end side in the connection pipe line 24. .

  The input unit 56 does not accept an operation input that uses both the treatment instrument 120 attached to the first drive unit 21 and the treatment instrument 120 attached to the second drive unit 41 at the same time. Thereby, the plurality of long portions 122 are not simultaneously inserted into the distal end tube portion 6.

  In the treatment instrument holding device 1 according to the present embodiment, in the cooperation unit 55, the input unit 56 may be configured to receive an operation input that neither the first drive unit 21 nor the second drive unit 41 is used. . In this case, the cooperation unit 55 detects the positions of the first drive unit 21 and the second drive unit 41 by referring to the detection unit 57. The link unit 55 is a drive unit (one of the first drive unit 21 and the second drive unit 41) in which the moving units 27 and 47 are close to the opening on the proximal end side of the connection pipes 24 and 44. On the other hand, the motors 29 and 49 are driven so that the moving parts 27 and 47 are separated from the openings on the base end sides of the connection pipes 24 and 44.

Next, the configuration of the manipulator 151 will be described.
As shown in FIG. 1, the manipulator 151 according to this embodiment includes a slave manipulator 152, a master manipulator 154, and a control unit 157. The treatment instrument 120 and the treatment instrument holding apparatus 1 are attached to the slave manipulator 152. The master manipulator 154 is electrically connected to the slave manipulator 152 and issues an operation command to the slave manipulator 152. The control unit 157 controls the entire medical system 150.

  The treatment instrument holding apparatus 1 according to the present embodiment corresponds to an operation input to the master manipulator 154, operates the electric traction means 14 based on a signal emitted from the slave manipulator 152, and electrically operates the bending portion 4 (FIG. 2). Reference) is configured to bend. Instead of the electric traction means 14, the bending portion 4 may be operated by an angle knob for manual operation.

  The slave manipulator 152 has a slave arm 153, an actuator (not shown), and a sensor (not shown). The slave arm 153 is attached with at least the treatment instrument 120 and the treatment instrument holding apparatus 1 described above. An actuator (not shown) operates the slave arm 153. A sensor (not shown) detects the position of the slave arm 153. The slave manipulator 152 operates the slave arm 153, the treatment instrument holding device 1, and the treatment instrument 120 in accordance with an operation command received from the master manipulator 154.

  The master manipulator 154 includes a master arm 155 and a display unit 156. The master arm 155 operates the treatment instrument 120 and the treatment instrument holding apparatus 1 when the operator Op holds and moves the master arm 155. The display unit 156 displays an image of a treatment target site and the like.

  When the master arm 155 is operated in the master manipulator 154, an operation command is issued from the master manipulator 154. The control unit 157 outputs a signal for operating the slave manipulator 152 to the slave manipulator 152 based on the operation command. Details of the configuration of the control unit 157 will be described later.

  Next, the operation of the medical system 150 and the treatment instrument holding apparatus 1 according to the present embodiment and the details of the configuration of the control unit 157 will be described. FIG. 4 is a schematic diagram showing a state in use of the treatment instrument holding apparatus 1 according to the present embodiment. FIG. 5 is a schematic diagram showing one process during use of the treatment instrument holding apparatus 1 according to the present embodiment. FIG. 6 is a schematic diagram showing one process during use of the treatment instrument holding apparatus 1 according to the present embodiment. FIG. 7 is a schematic diagram showing one process during use of the treatment instrument holding apparatus 1 according to the present embodiment.

  When the treatment instrument holding device 1 is used, first, the insertion portion 2 is guided into the body so that the distal end 2a of the insertion portion 2 is positioned at the position of the treatment target site T (see FIG. 4). If necessary, the bending portion 4 is bent using the electric traction means 14 for bending operation or a knob for bending operation (not shown) to adjust the position and posture of the distal end 2a of the insertion portion 2 to a suitable state. Also good.

  Subsequently, the treatment instrument 120 is inserted into the first treatment instrument insertion port 16 and the second treatment instrument insertion port 17. When the treatment instrument 120 is inserted into the first treatment instrument insertion port 16 and the second treatment instrument insertion port 17, the joint portion 124 of the treatment instrument 120 is in a relaxed state and is relaxed so that it can bend freely. preferable.

  The endoscope treatment tool 120 may be attached to only one of the first treatment tool insertion port 16 and the second treatment tool insertion port 17. In the present embodiment, a case where the endoscope treatment tool 120 is inserted and used in both the first treatment tool insertion port 16 and the second treatment tool insertion port 17 will be described.

  When the treatment instrument 120 is inserted into the first treatment instrument insertion port 16 and the second treatment instrument insertion port 17, the active bending operation of the joint portion 124 can be performed by the master manipulator 154. When each treatment instrument 120 is arranged in the proximal end pipe part 7, the joint part 124 is in a relaxed state. When the treatment instrument 120 is projected from the opening on the distal end side of the distal end tube portion 6, the joint portion 124 can bend with respect to the master manipulator 154 according to the operation of the operator Op.

  In the present embodiment, the joint portion 124 of the treatment instrument 120 is curved in accordance with the operation of the operator Op with respect to the master manipulator 154, and the treatment target site can be treated with a suitable position and posture. When switching from one of the two treatment tools 120 being used to the other not being used, first, the operator Op performs an operation input for changing the treatment tool 120 to be used in the master manipulator 154.

  As shown in FIG. 5, when one treatment tool 120A is selected from two treatment tools 120 and used, the treatment tool holding device 1 has only the treatment part 121A of the selected first treatment tool 120A as an insertion part. 2 is fed out from the tip 2a. When the first treatment portion 121A (the treatment portion 121 of the treatment instrument 120 inserted through the first proximal tube portion 8) is being fed from the distal end 2a of the insertion portion 2 through the distal tube portion 6, the second treatment is performed. The treatment portion 121B of the instrument 120B is disposed in the second proximal end tube portion 9. When the use of the first treatment instrument 120A is ended or interrupted and the second treatment instrument 120B is changed to the second treatment instrument 120B, the operator Op inputs an operation to the input unit 56 provided in the cooperation unit 55, thereby FIG. As shown, the treatment part 121A attached to the long part 122A of the first treatment instrument 120A is pulled back into the first proximal end pipe part 8 by the electric drive of the motor 29 as a power source, and the second treatment instrument 120B The long portion 122B is pushed into the distal end tube portion 6 by electric drive of a motor 49 as a power source.

  In the process of changing the treatment tool from the first treatment tool 120A to the second treatment tool 120B, the control unit 157 first relaxes the joint part 124 with respect to the first treatment tool 120A in use. That is, the electric traction means 14 releases the traction force on the bending wire connected to the joint portion 124. Subsequently, the control unit 157 moves the drive unit 20 (the first drive unit 21 or the second drive unit 41) corresponding to the first treatment tool 120A in use with respect to the cooperation unit 55 of the treatment tool holding device 1. A signal for moving the part toward the base end side of the base part is generated. The coordinating unit 55 that has received the input of the signal draws the first treatment instrument 120A in use into the proximal end pipe part 7 by the electric drive of the motor 29 that is a power source, and powers the second treatment instrument 120B. It is pushed into the distal end pipe section 6 by electric drive of a motor 49 as a source. The control unit 157 can control the protrusion amount of the treatment tool 120 protruding from the distal end of the insertion unit 2. For example, the position where the first treatment instrument 120A that was in use protrudes is stored, and the protrusion position of the second treatment instrument 120B to be replaced can be limited to the stored position. . The process of changing the treatment tool will be described based on the flowchart shown in FIG. First, the control unit 157 receives a treatment instrument replacement instruction (step S200). Receiving the treatment instrument replacement instruction, the control unit 157 shifts from the master slave mode to the treatment instrument replacement mode (step S205). The control unit 157 that has shifted to the treatment instrument replacement mode records the position of the protruding treatment instrument (step S210). Subsequently, the control unit 157 retracts the treatment instrument 120 using the cooperation unit 55 (step S215). After the retraction of the first treatment instrument 120A in step S215 is completed, the second treatment instrument 120B to be replaced is advanced to the position recorded in step S210 (steps S220 to S235). When the advance stop signal is input during the movement of the second treatment instrument 120B after the advancement of the second treatment instrument 120B is started in step S220, the process proceeds to step S235 due to the conditional branch in step S225, and the treatment tool Stop moving forward. When the advancement of the second treatment instrument 120B stops, the control unit 157 shifts to the master-slave standby mode (step S240). Assuming that there is no affected part or the like up to the place where the first treatment tool 120A protrudes immediately before the treatment tool replacement, the control unit 157 determines the initial position at the time of replacement of the second treatment tool 120B to be replaced before the replacement. By limiting to the protruding position of the first treatment tool 120A, the treatment tool can be replaced more reliably.

  The controller 157 may prevent the movement of the master arm 155 from being transmitted to the slave manipulator 152 even if the master arm 155 is moved while the treatment instrument 120 is being replaced in the treatment instrument holding apparatus 1.

  When the second treatment instrument 120B to be used from now on is extended (protruded) from the distal end of the insertion portion 2, the control unit 157 controls the joint portion 124 of the second treatment instrument 120B to have a predetermined initial posture. Then, the input from the master arm 155 by the operator Op is accepted. The operator Op can adjust (control) the protrusion amount (advance / retreat amount) with respect to the living tissue using the second treatment tool 120B after switching, and can treat the living tissue that is the treatment target.

  In the state where the first treatment instrument 120A is used, the second treatment instrument 120B which is pulled back into the second proximal end tube portion 9 by the electric drive of the motor 49 which is a power source and is not used for the treatment is a joint portion. 124 is in a relaxed state. Therefore, it can be removed from the channel tube 5 by manual work or the like without interfering with the first treatment instrument 120A in use and without interfering with the inner wall or the like of the channel tube 5 as shown in FIG. Thereafter, even when another treatment tool (not shown) is attached to the vacant channel tube 5, the first treatment tool 120A in use is not interfered.

  Since the joint part 124 of the treatment instrument 120 is substantially a hard part when a traction force that maintains the joint shape is applied, it may be difficult to pass through the soft channel. In the present embodiment, the treatment tool can be replaced without damaging the channel by relaxing the joint portion 124 in accordance with the timing of the treatment tool replacement.

  In FIG. 1, the treatment for the upper digestive tract in which the treatment instrument holding apparatus 1 according to the present embodiment is inserted from the mouth is shown, but the medical system 150 and the treatment instrument holding apparatus 1 according to the present embodiment are inserted from the anus. The gastrointestinal tract may be used for the lower digestive tract, and can be used even when a small incision is provided in the abdomen.

  In the treatment tool holding device 1 according to the present embodiment, when the first treatment tool 120A and the second treatment tool 120B arranged in the channel tube 5 are used while being switched, the first treatment tool 120A and the second treatment tool 120B are used. Need not be completely removed from the channel tube 5. If the first treatment instrument 120A is pulled toward the proximal end so that the treatment part 121A in the first treatment instrument 120A is located at least on the proximal end side with respect to the connection part 10, the treatment part 121B and the length in the second treatment instrument 120B The scale portion 122B is fed out from the distal end of the insertion portion 2 through the distal end tube portion 6 without interfering with the first treatment instrument 120A. Furthermore, the protrusion amount (advance / retreat amount) of the treatment instrument 120 protruding from the distal end of the insertion portion 2 can be controlled by the drive unit 20 that moves the treatment instrument 120. The initial position at the time of replacement of the second treatment tool 120B to be replaced is based on the assumption that the affected part does not exist until the place where the first treatment tool 120A protrudes immediately before the replacement. Can be limited to position. The electric exchange of the treatment instrument 120 and the adjustment of the advance / retreat amount when the treatment instrument 120 protrudes can be realized with the same linear motion mechanism and in a small size.

  In the treatment instrument holding apparatus 1 according to the present embodiment, the length for moving the long portion 122 to replace the treatment instrument 120 is short, and the treatment instruments 120 do not interfere with each other. As a result, the treatment instrument holding apparatus 1 according to the present embodiment shortens the switching time of the plurality of treatment instruments 120 and realizes excellent operability.

  Moreover, since the connection part 10 in the channel tube 5 is arranged in the flexible tube part 3 and in the vicinity of the boundary between the flexible tube part 3 and the bending part 4, the flexibility of the bending part 4 is high. .

    As a bending portion provided in a known flexible endoscope apparatus, a plurality of cylindrical members are connected so as to be rotatable, and each cylindrical member is rotated so that the lumen of the bending portion is not crushed. A bending portion that bends while maintaining its shape is known. However, when such a cylindrical member is provided, the lumen of the bending portion may be narrower than the lumen of the flexible tube portion. In the treatment instrument holding apparatus 1 according to the present embodiment, there is one conduit that is a treatment instrument channel in the bending portion 4, and the conduit is branched into two in the connection portion 10 located outside the bending portion 4. Therefore, even if the lumen of the bending portion 4 is narrow, the channel tube 5 can be arranged in the bending portion 4 without impairing the function of the bending portion 4.

When the cooperation part 55 is not provided, when the two long parts 122 are forcibly pushed into the distal end pipe part 6, the two long parts 122 interfere with each other. As a result, there is a possibility that treatment using the two long portions 122 cannot be performed. Further, there is a possibility that the two treatment tools 120 cannot be extracted from the channel tube 5 of the treatment tool holding apparatus 1.
In the treatment instrument holding apparatus 1 according to the present embodiment, since the cooperation portion 55 is provided, the operator Op can mistakenly insert the long portions 122 of the two treatment instruments 120 into the distal end tube portion 6 at the same time. Is prevented. It is also possible to prevent the other treatment instrument 120 from being inserted into the distal end tube portion 6 in a state where one of the two treatment devices 120 is disposed in the distal end tube portion 6. The risk that the treatment work using the treatment tool holding device 1 is interrupted can be kept low without the plurality of treatment tools 120 interfering with each other in the distal end tube portion 6 due to an erroneous operation by the operator Op.

  The treatment instrument holding apparatus 1 according to the present embodiment includes the imaging unit 11 and can substantially function as an endoscope. For this reason, it is not necessary to introduce another endoscope for imaging the region to be treated into the body, and the burden on the patient is small.

(Second Embodiment)
Next, a treatment instrument holding apparatus 200 and an endoscope according to a second embodiment of the present invention will be described. FIG. 8 is a schematic view showing a part of the treatment instrument holding apparatus 200 according to the second embodiment of the present invention.
As shown in FIG. 8, in the present embodiment, the drive unit 20 is provided with a check unit 60 for preventing the long portions 122 of the two treatment instruments 120 from being simultaneously inserted into the distal end tube unit 6. It has been.

  The check unit 60 includes a stopper unit 61, a switch 65, a first sensor wire 68, and a second sensor wire 69. The stopper unit 61 is a two-branched tubular stopper unit. The switch 65 is disposed at a branch portion of the stopper unit 61. The first sensor wire 68 is fixed to the moving unit 27 of the first driving unit 21 and is inserted through the stopper unit 61. The second sensor wire 69 is fixed to the moving unit 47 of the second driving unit 41 and inserted through the stopper unit 61.

  The stopper unit 61 is provided with one pipe line 62 on one end 61a (hereinafter referred to as the tip of the stopper unit 61 and the check unit 60). The stopper unit 61 is bifurcated so that two pipes 63 and 64 are arranged on the other end 61b (hereinafter referred to as the base end of the stopper unit 61 and the check unit 60). The inner diameter of one pipe line 62 arranged on the distal end side is such a size that when either one of the first sensor wire 68 and the second sensor wire 69 is inserted, the other cannot be inserted.

  The switch 65 is a contact switch disposed in the vicinity of the branch portion of the stopper unit 61 in a region closer to the base end than the branch portion. The switch 65 includes a first switch 66 that contacts the first sensor wire 68 and a second switch 67 that contacts the second sensor wire 69. The switch 65 is not limited to a contact type, and may be a non-contact sensor using light or magnetism.

  The first sensor wire 68 is a linear elastic member that is inserted into the pipe 63 that is one of the two pipes 63 and 64 on the base end side in the stopper unit 61 from the base end side toward the distal end side. The first sensor wire 68 operates integrally with the moving unit 27 of the first driving unit 21 and functions as a sensor for detecting the position of the moving unit 27. The first sensor wire 68 is attached to the first drive unit 21 and when the treatment unit 121 provided on the treatment instrument 120 disposed in the channel tube 5 enters the connection unit 10 of the channel tube 5 from the proximal end side. The tip 68 a of the first sensor wire 68 is disposed so as to enter the pipe 62 on the tip side of the stopper unit 61 and occupy the pipe 62.

  The second sensor wire 69 is a linear elastic member that is inserted from the proximal end side toward the distal end side into the conduit 64 that is the other of the two conduits 63 and 64 on the proximal end side in the stopper unit 61. The second sensor wire 69 operates integrally with the moving unit 47 of the second drive unit 41 and functions as a sensor for detecting the position of the moving unit 47. The second sensor wire 69 is attached to the second drive unit 41 and when the treatment part 121 provided on the treatment instrument 120 disposed in the channel tube 5 enters the connection part 10 of the channel tube 5 from the proximal end side. The distal end 69 a of the second sensor wire 69 is arranged so as to enter into the conduit 62 on the distal end side of the stopper unit 61 and occupy the interior of the conduit 62.

Next, the operation of the treatment instrument holding device 200 according to this embodiment will be described.
In the treatment instrument holding apparatus 200 according to the present embodiment, when the first sensor wire 68 contacts the first switch 66, the long portion 122A of the first treatment instrument 120A attached to the first drive unit 21 is the tip tube. It can be determined that the unit 6 is arranged. Conversely, when the second sensor wire 69 comes into contact with the second switch 67, it is determined that the long portion 122B of the treatment instrument 120B attached to the second drive portion 41 is disposed in the distal end tube portion 6. it can.

  Furthermore, only one of the first sensor wire 68 and the second sensor wire 69 can be inserted into the pipe line 62 on the distal end side of the stopper unit 61. Even if the long portion 122A of the first drive portion 21 and the long portion 122B of the second drive portion 41 are both pushed into the distal end tube portion 6 due to malfunction, the branch lines 62, 63, 64 in the stopper unit 61 are branched. The first sensor wire 68 and the second sensor wire 69 interfere with each other. Before the treatment part 121A of the first treatment tool 120A and the treatment part 121B of the second treatment tool 120B completely enter the connection part 10, the operations of the first drive part 21 and the second drive part 41 are mechanically limited. The

  In the treatment instrument holding device 200 according to the present embodiment, it is possible to mechanically limit the simultaneous insertion of the plurality of long portions 122A and 122B into the distal end tube portion 6 of the channel tube 5, and it is simple and reliable. It has a high configuration.

(Third embodiment)
Next, a treatment instrument holding apparatus 300 and an endoscope according to a third embodiment of the present invention will be described. FIG. 9 is a schematic view showing a part of the treatment instrument holding apparatus 300 according to the third embodiment of the present invention.
As illustrated in FIG. 9, the treatment instrument holding device 300 according to the present embodiment includes a check unit 70 having a configuration different from that of the check unit 60 described in the above-described embodiment.

  The check unit 70 includes a switch 71 and a support unit 72. The switch 71 is a rod-like switch having a center of rotation between the first drive unit 21 and the second drive unit 41. The switch 71 can contact the moving unit 27 of the first drive unit 21 and the moving unit 47 of the second drive unit 41. The support 72 enables the switch 71 to rotate about the rotation center and supports the switch 71.

  In the treatment instrument holding device 300 according to the present embodiment, the first drive unit 21 and the second drive unit 41 are configured such that the moving unit 27 of the first drive unit 21 can move in the movable direction of the first drive unit 21 and the moving unit 47 of the second drive unit 41. It is attached to the base 18 so that the movable directions are parallel to each other.

  The support part 72 is fixed to the base 18. The position of the support part 72 with respect to the first drive part 21 and the second drive part 41 is such that the treatment part 121A of the first treatment instrument 120A and the treatment part 121B of the second treatment instrument 120B are slightly proximal from the connection part 10. The moving unit 27 of the first driving unit 21 and the moving unit 47 of the second driving unit 41 are set so as to be in contact with the switch 71 in a state of being located on the 7 side.

  In the treatment instrument holding device 300 according to the present embodiment, even if the moving unit 27 of the first driving unit 21 and the moving unit 47 of the second driving unit 41 operate so as to simultaneously press the switch 71 due to malfunction, One of the treatment part 121A of the treatment tool 120A and the treatment part 121B of the second treatment tool 120B is always in a state of being drawn into the proximal end pipe part 7. Therefore, in the present embodiment, interference between the long portions 122A and 122B in the distal end tube portion 6 does not occur.

  Further, depending on the direction in which the switch 71 is pushed around the rotation center, one of the first treatment instrument 120A attached to the first drive unit 21 and the second treatment instrument 120B attached to the second drive unit 41 is connected to the distal end tube. It can be determined whether it is inserted into the part 6 and is in use.

(Fourth embodiment)
Next, a treatment instrument holding apparatus 400 and an endoscope according to a fourth embodiment of the present invention will be described. FIG. 10 is a schematic view showing a part of the treatment instrument holding apparatus 400 according to the fourth embodiment of the present invention.
As shown in FIG. 10, in the treatment instrument holding device 400 according to the present embodiment, the moving unit 27 of the first driving unit 21 and the moving unit 47 of the second driving unit 41 are connected instead of the above-described cooperation unit 55. A connecting member 75 is provided. The connecting member 75 has a rotation center 75 a between the first drive unit 21 and the second drive unit 41.

  In the treatment instrument holding apparatus 400 according to the present embodiment, any one of the first drive unit 21 and the second drive unit 41 may be actively operated. For example, if the first drive unit 21 is provided with a drive unit using a rack and pinion and a motor, the second drive unit 41 may be a rail that moves the moving unit 47 linearly with respect to the base 42.

In the treatment instrument holding device 400 according to the present embodiment, unlike the third embodiment described above, the movement unit 27 of the first drive unit 21 and the movement unit 47 of the second drive unit 41 are each operated by a connecting member 75. Is always restrained by. When the moving part 27 of the first driving unit 21 is operated so as to push the long part 122 </ b> A toward the distal end side of the channel tube 5, the moving part 47 of the second driving part 41 causes the long part 122 </ b> B to move to the proximal end side of the channel tube 5. Behaves responsively to pull in.
If means for directly rotating the connecting member 75 around the rotation center 75a is provided, means for directly driving the first drive unit 21 and the second drive unit 41 is not essential.

(Fifth embodiment)
Next, a treatment instrument holding apparatus 500 and an endoscope according to a fifth embodiment of the present invention will be described. FIG. 11 is a schematic view showing a part of a treatment instrument holding apparatus 500 according to the fifth embodiment of the present invention.
As shown in FIG. 11, in this embodiment, instead of the connecting member 75 described in the fourth embodiment, a pair of pulleys 76 and 77, a wire 78, and a motor 79 are provided. The wire 78 is a continuous ring-shaped wire hung on the pulleys 76 and 77. The motor 79 rotates one of the pair of pulleys 76 and 77 (the pulley 76 in the present embodiment).

  The first drive unit 21 and the second drive unit 41 do not have rack and pinion and motor drive means for moving the moving units 27 and 47 with respect to the base units 22 and 42. The first drive unit 21 and the second drive unit 41 are configured such that the moving units 27 and 47 move back and forth along the rails and the like with respect to the base units 22 and 42 by rails and the like. In the present embodiment, the movable direction of the moving unit 27 of the first driving unit 21 and the movable direction of the moving unit 47 of the second driving unit 41 are parallel to each other.

  In the treatment instrument holding apparatus 500 according to the present embodiment, the moving unit 27 of the first driving unit 21 and the moving unit 47 of the second driving unit 41 are moved forward and backward by the driving force of the motor 79 that rotates the pair of pulleys 76 and 77. To do. The wire 78 is hung on a pair of pulleys 76 and 77 disposed between the first drive unit 21 and the second drive unit 41. The wire 78 is arranged so as to be an ellipse whose major axis is along the movable direction of the moving unit 27 of the first driving unit 21 and the moving unit 47 of the second driving unit 41.

  A portion (indicated by reference numeral 78 a) located on the side close to the first drive unit 21 in the wire 78 hung on the pair of pulleys 76 and 77 is connected to the moving unit 27 of the first drive unit 21. A portion (indicated by reference numeral 78 b) located on the side close to the second drive unit 41 in the wire 78 hung on the pair of pulleys 76 and 77 is connected to the moving unit 47 of the second drive unit 41.

  In the treatment instrument holding apparatus 500 according to the present embodiment, when the pair of pulleys 76 and 77 are rotated by the motor 79, a portion close to the first drive unit 21 and the second portion of the wire 78 hung on the pulleys 76 and 77. The parts close to the drive unit 41 move in directions opposite to each other. For this reason, when the pair of pulleys 76 and 77 rotate, the first drive unit 21 and the second drive unit 41 are pushing the one treatment instrument 120 into the distal end tube unit 6. The other of 21 and the second drive part 41 pulls the other treatment tool 120 into the proximal end pipe part 7.

  Therefore, in the treatment instrument holding apparatus 500 according to the present embodiment, the treatment section 121 and the long section 122 of the two treatment instruments 120 do not interfere with each other in the distal end tube section 6 as in the first embodiment.

(Sixth embodiment)
Next, a treatment instrument holding apparatus 1 and an endoscope according to a sixth embodiment of the present invention will be described. FIG. 12 is a schematic view showing a part of the treatment instrument holding apparatus 1 according to the sixth embodiment of the present invention. FIG. 13 is a schematic enlarged view showing a part of the treatment instrument holding apparatus 1 according to the embodiment.

  In the treatment instrument holding apparatus 1 according to the present embodiment, the first drive unit 21 and the second drive unit 41 operate freely along the rails and the like, similarly to the fifth embodiment described above. As shown in FIG. 12, driving means 80 is provided that selects and operates the moving unit 27 of the first driving unit 21 and the moving unit 47 of the second driving unit 41. Further, the moving unit 27 of the first driving unit 21 and the moving unit 47 of the second driving unit 41 have stoppers 87 and 97 for individually fixing the positions of the moving units 27 and 47 with respect to the base units 22 and 42, respectively. Is provided.

  The driving means 80 according to the present embodiment includes a screw 81, a motor 82, a nut portion 83, and a switching unit 84. The screw 81 is a rod-like screw extending in a direction parallel to the movable direction of the moving unit 27 of the first driving unit 21 and the moving unit 47 of the second driving unit 41. The motor 82 rotates the screw around the screw center line. The nut portion 83 is fitted to the screw 81. The switching unit 84 is provided in the nut portion 83 and is selectively connected to the moving portions 27 and 47.

  The switching unit 84 includes a moving body 85 and an actuator 86. The moving body 85 has irregularities that move with respect to the nut portion 83 in a direction orthogonal to the center line of the screw 81 and engage with the moving portions 27 and 47. The actuator 86 moves the moving body 85 with respect to the nut portion 83. In the present embodiment, the moving unit 27 of the first driving unit 21 and the moving unit 47 of the second driving unit 41 are provided with unevenness that engages the moving body 85 of the switching unit 84.

  As shown in FIG. 13, the stopper 87 provided on the moving unit 27 of the first drive unit 21 includes a stopper pin 88 and a release mechanism 89. The stopper pin 88 is urged by a coil spring or the like so as to contact the base portion 22. The release mechanism 89 separates the stopper pin 88 from the base portion 22 when the moving body 85 comes into contact therewith. In this embodiment, the release mechanism 89 includes a release pin 90 with which the moving body 85 abuts and a gear 91 that transmits the operation of the release pin 90 to the stopper pin 88. The stopper pin 88 and the release pin 90 are supported by the moving portions 27 so as to be movable in parallel with each other. The stopper pin 88 and the release pin 90 are formed with racks (tooth teeth). The gear 91 of the release mechanism 89 meshes with the rack of the stopper pin 88 and the rack of the release pin 90 so that the stopper pin 88 and the release pin 90 move in directions opposite to each other.

  The stopper 97 provided in the moving part 47 of the second drive part 41 has the same configuration as the stopper 87 provided in the moving part 27 of the first drive part 21. The stopper 97 provided in the moving part 47 of the second drive unit 41 has a stopper pin 98, a release pin 100, and a release mechanism 99 having a gear 101.

  In the treatment instrument holding apparatus 1 according to the present embodiment, the nut portion 83 is moved by rotating the screw 81. Thereby, the moving body 85 is conveyed along the center line direction of the screw 81 to one of the moving unit 27 of the first driving unit 21 and the moving unit 47 of the second driving unit 41. Further, the actuator 86 of the switching unit 84 is moved to the moving body 85 so that the unevenness of the moving body 85 is engaged with any uneven portion of the moving portion 27 of the first driving portion 21 and the moving portion 47 of the second driving portion 41. Move.

  When the moving body 85 is engaged with the moving portion 27 of the first driving portion 21, the stopper pin 88 is separated from the base portion 22 in the stopper 87, and the moving portion 27 of the first driving portion 21 can move with respect to the base portion 22. It is.

  When the moving body 85 is engaged with the moving portion 47 of the second driving portion 41, the stopper pin 98 is separated from the base portion 42 in the stopper 97, and the moving portion 47 of the second driving portion 41 can move with respect to the base portion 42. It is.

  In the treatment instrument holding apparatus 1 according to the present embodiment, one of the moving unit 27 of the first driving unit 21 and the moving unit 47 of the second driving unit 41 that is selected by the driving unit 80 can be operated. The other not selected does not work.

When the screw 81 rotates around the center line in this state, the nut portion 83 advances and retreats in the direction of the center line of the screw 81, and the one of the moving portions 27 and 47 to which the moving body 85 is engaged is integrated with the nut portion 84. Then, the screw 81 advances and retreats in the direction of the center line of the screw 81.
Even if it is the structure which concerns on this embodiment, there exists an effect similar to the above-mentioned 1st Embodiment.

(Seventh embodiment)
Next, a treatment instrument holding apparatus 1 and an endoscope according to a seventh embodiment of the present invention will be described. FIG. 14 is a schematic view showing a part of the treatment instrument holding apparatus 1 according to the seventh embodiment of the present invention.
As shown in FIG. 14, the treatment instrument holding apparatus 1 according to the present embodiment has traction means 110 that pulls the treatment instrument 120 back to the proximal side, instead of the stoppers 87 and 97 described in the sixth embodiment. doing.

  The traction means 110 in the treatment instrument holding apparatus 1 according to the present embodiment includes a tension coil spring 111 and a tension coil spring 112. One end of the tension coil spring 111 is fixed to the moving portion 27 of the first drive portion 21, and the other end is fixed to the base portion 22 of the first drive portion 21. One end of the tension coil spring 112 is fixed to the moving part 47 of the second drive unit 41, and the other end is fixed to the base part 42 of the second drive unit 41.

  In the treatment instrument holding apparatus 1 according to the present embodiment, when the moving body 85 described in the sixth embodiment is separated from the moving section 27 of the first driving section 21 or the moving section 47 of the second driving section 41, the moving body 85. The moving parts 27 and 47 released from the engagement with are moved to the proximal end side by the tension coil springs 111 and 112. In the present embodiment, the moving body 85 selectively engages with only one of the moving unit 27 of the first driving unit 21 and the moving unit 47 of the second driving unit 41. In the treatment instrument holding apparatus 1 according to the present embodiment, the moving body 85 does not engage with the moving unit 27 of the first driving unit 21 and the moving unit 47 of the second driving unit 41 at the same time. The moving part is always located at the base end of the base part of any one of the first drive part 21 and the second drive part 41.

  Even in the configuration according to the present embodiment, the interference between the treatment portion 121 and the long portion 122 in the two treatment tools 120 is prevented as in the above-described embodiments.

  In the above embodiment, the imaging unit 11 may not be provided in the treatment instrument holding device 1. In other words, the treatment instrument holding device 1 may not have the observation or imaging function provided in a general endoscope apparatus. The treatment instrument holding apparatus 1 that does not include the imaging unit 11 is preferably configured so that the user can visually know the position of each treatment instrument 120 held by the treatment instrument holding apparatus 1. For example, the treatment instrument holding device 1 that does not include the imaging unit 11 is preferably used together with an observation unit such as a known endoscope device or an ultrasonic endoscope.

  The preferred embodiments of the present invention have been described above, but the present invention is not limited to these embodiments. Additions, omissions, substitutions, and other modifications can be made without departing from the spirit of the present invention. The present invention is not limited to the above description, but is limited only by the scope of the appended claims.

  In each of the above embodiments, a plurality of treatment instruments can be easily switched without interfering with each other.

DESCRIPTION OF SYMBOLS 1 Treatment tool holding | maintenance apparatus 2 Insertion part 2a Tip 2b Base end 3 Flexible tube part 4 Bending part 6 Tip pipe part 7 Base end pipe part 8 1st base end pipe part 9 2nd base end pipe part 10 Connection part 11 Imaging means DESCRIPTION OF SYMBOLS 12 Operation part 20 Drive part 21 1st drive part 41 2nd drive part 55 Cooperation part 62,63,64 Pipe line 120 Treatment tool 120A First treatment tool 120B Second treatment tool 121 Treatment part 122,122A, 122B Long part 123 Attachment part 124 Joint part 150 Medical system 151 Manipulator 152 Slave manipulator 154 Master manipulator 155 Master arm 157 Control part Op Operator

Claims (9)

A treatment instrument holding device that holds a plurality of treatment instruments,
A flexible insertion portion having a distal end and a proximal end and having a treatment instrument channel through which the plurality of treatment instruments are inserted;
A drive unit that causes the treatment instrument channel to advance and retract each of the plurality of treatment instruments within the treatment instrument channel;
An operation unit for operating the plurality of treatment tools;
A control unit for controlling a protruding amount of the treatment tool protruding from the distal end of the treatment tool channel from the treatment tool channel;
Have
The insertion part is
A distal end pipe part which is one duct having an opening on the distal end side of the insertion part;
A first base end pipe part which is one pipe having an opening on the base end side of the insertion part;
A second proximal end pipe part which is one duct having an opening on the proximal end side of the insertion part;
The distal end tube portion, the first proximal end tube portion, and the second proximal end tube portion are connected in a state where the distal end tube portion, the first proximal end tube portion, and the second proximal end tube portion communicate with each other. And a connecting portion disposed in the insertion portion,
A treatment instrument holding device. The insertion part is
A flexible flexible tube;
A bending portion that is disposed on a distal end side of the insertion portion and is connected to the flexible tube portion to bend;
Have
The treatment tool holding device according to claim 1, wherein the connection portion is disposed in the flexible tube portion and in the vicinity of a boundary between the flexible tube portion and the bending portion. In the treatment instrument, the drive unit holds a part of the treatment tool that is extended from the proximal end side of the treatment tool channel to the outside of the insertion part, and moves the held part forward and backward. The treatment instrument holding device according to claim 1, wherein a portion inserted into the treatment instrument channel is moved forward and backward in a pipe center axis direction of the treatment instrument channel. The drive unit is
A first drive unit that causes the treatment tool inserted into the first proximal tube portion to advance and retract by a length between the distal end of the distal tube portion and the connection portion;
A second drive unit that causes the treatment tool inserted into the second proximal tube portion to advance and retract by a length between the distal end of the distal tube portion and the connection portion;
When the treatment instrument inserted into the first proximal tube is in the distal tube part, the treatment tool inserted into the second proximal tube part is drawn into the second proximal tube part immediately before the connection part. And when the treatment tool inserted into the second proximal tube portion is in the distal end tube portion, the treatment device inserted into the first proximal tube portion is disposed immediately before the connection portion. A linkage unit that cooperates with the first drive unit and the second drive unit so as to be pulled into and held in the end tube unit;
The treatment instrument holding device according to claim 1 or 2. The shape of the cross section orthogonal to the central axis of the distal end tube portion, the shape of the cross section orthogonal to the central axis of the first proximal tube portion, and the shape of the cross section orthogonal to the central axis of the second proximal tube portion Are almost the same,
An area of a cross section perpendicular to the central axis of the distal end pipe part, an area of a cross section perpendicular to the central axis of the first proximal pipe part, and an area of a cross section perpendicular to the central axis of the second proximal pipe part These are substantially the same. The treatment tool holding device according to any one of claims 1 to 4. The treatment tool is
A treatment unit for treating a treatment target;
A long portion connected to the treatment portion and inserted into the treatment instrument channel,
When the distal end tube part is capable of inserting the treatment part and the long part in only one treatment instrument and simultaneously inserting the treatment part and the long part in two or more treatment instruments The treatment instrument holding device according to claim 5, wherein the treatment portion and the long portion are tubes having dimensions that interfere with each other. The treatment tool is
A first treatment tool and a second treatment tool;
The controller is
When the protrusion amount of the first treatment instrument protruding from the distal end of the treatment instrument channel is recorded and the first treatment instrument protruding from the distal end is retracted to cause the second treatment instrument to protrude from the distal end of the treatment instrument channel The amount of protrusion of the second treatment tool from the treatment tool channel is limited so that the second treatment tool is protruded only up to a recorded protrusion amount. Treatment tool holding device. The treatment instrument holding device according to any one of claims 1 to 7,
An imaging means provided in the insertion portion for imaging the treatment target;
Endoscope equipped with. The treatment instrument holding device according to any one of claims 1 to 7,
A plurality of treatment tools for treating a treatment target;
A manipulator for operating the treatment instrument holding device and the plurality of treatment instruments;
With
The plurality of treatment tools include:
A treatment section for treating the treatment target;
A long portion connected to the treatment portion and inserted into the treatment instrument channel;
A joint part that connects the treatment part and the long part and changes the posture of the treatment part with respect to the long part;
A wire that is arranged in the elongated portion and transmits a force for operating the joint portion;
With
The manipulator
A master manipulator that accepts operation input from the operator;
A slave manipulator that is electrically connected to the master manipulator and operates the wire in accordance with the operation input to the master manipulator;
A controller that is electrically connected to the master manipulator and the slave manipulator to control the posture of the joint;
Have
The control portion relaxes the joint portion when a stop command for the treatment instrument having the joint portion is issued to the manipulator in a state where the joint portion is extended from the distal end tube portion. To generate a signal to operate the wire and output to the slave manipulator,
When the joint portion is in a relaxed state by the signal, a signal for pulling the treatment portion and the long portion until the treatment portion is located in the first proximal end tube portion or the second proximal end tube portion. A medical system that outputs to the slave manipulator.

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